The shrinking reality of “legal” abortion

As of October 21, 2025, abortion protections exist in 31 states and the District of Columbia, yet access is dramatically shrinking because of federal funding cuts, hospital policies, and new national pressure on abortion pills. Note - this post was updated on December 9 to include new contraception information.

The 30-second version -

• Abortion remains legal/protected in 31 states and DC, yet access is tightening through funding freezes, hospital policies, and new pressure on medication abortion.
• Clinic capacity is dipping as Title X and Medicaid-related restrictions ripple through large health centers.
• Hospital policy and EMTALA enforcement gaps are limiting emergency care in some health systems.
• Abortion pills face renewed national pressure that could affect access regardless of state law.

What's Changed

Federal funding cuts and clinic capacity - Planned Parenthood affiliates across the country have paused services or closed clinics as a result of the ongoing freeze of Title X family planning grants, and the looming Medicaid cuts to large health centers that include abortions in their list of services. To date -

• 42 clinics have closed or will be closing, and one has paused abortion services.
• 29 clinics are in states with some level of abortion protection - WI, NY, NV, CA, MN, IL, NJ, OH, PA, VT, and MI.
• Planned Parenthood has filed a lawsuit on behalf of its impacted affiliates and is awaiting a decision. If the cuts go through, an estimated one-third (200) of their clinics will be forced to close.

Hospital policies and emergency care - Recent lawsuits reveal how both religious hospital policies and weakened federal enforcement are converging to limit emergency reproductive care. In California, two Catholic health systems have lawsuits pending after 3 women were denied emergency abortion care. A similar story is playing out in Illinois. In contrast, an EMTALA lawsuit in Kansas targets the University of Kansas Health System, a public hospital accused of violating federal law by refusing to stabilize a patient after her membranes ruptured at 18 weeks.

Abortion medication - On October 9, 51 Senate Republicans sent a letter urging FDA and HHS to suspend access to mifepristone—including the newly approved generic—which would impact everyone's ability to get abortion pills, regardless of a state's abortion landscape.

Other things to watch: The Trump administration's labeling of the USAID contraception as "abortifacients" in September, the rise of "crisis pregnancy centers" and an imminent Supreme Court decision on them, and the Heritage Foundation's request for Secretary Kennedy to study the birth control pill.

Why it Matters

The center of gravity has shifted from law to logistics: even where abortion is legal, coordinated pressure on funding, hospitals, and medication turns a protected right into a practical impossibility for many. This is a workaround to state and federal protections—a national strategy in line with Project 2025 that limits access upstream (Medicaid, ER policies, medication by mail) so the promise of legality collapses at the point of care. The result is predictable: longer delays, higher costs, restricted access, avoidable medical risk, and the widest harm for women who rely on Medicaid, live far from care, or face hospital religious restrictions.

Background

Mifepristone was approved by the FDA 25 years ago and offers a safe, accessible, and more private option to surgical abortion. According to the Guttmacher Institute, medication abortion accounted for 63% of all abortions provided in the US in 2023. The recent approval of a new generic version of mifepristone has caused outrage among anti-abortion groups. 

After Roe v. Wade was overturned in 2022, the Biden administration did two things to protect abortion access at the federal level and emergency reproductive care in anti-abortion states: First, it allowed patients to obtain the medication through the mail, without an in-person appointment. Second, it added clarifications to existing EMTALA legislation around emergency abortion procedures. President Trump rescinded the latter on May 29, 2025.

The Guttmacher Institute opinion piece linked below details the post-Dobbs landscape from the perspective of anti-abortion groups.

And finally, here is a summary of Project 2025 on abortion rights (sourced from MSI): 

• Limit access to abortion across the US
• Withdraw the FDA’s approval of mifepristone and remove it from the market
• Ban abortion pills, equipment, or materials from being sent through USPS
• Dismantle abortion protections under EMTALA
• Increase data collection on abortion and require all states to report all abortions that take place—states that don’t share abortion data will have federal funds withheld

Things to Know

• Title X: A federal grant program supporting family-planning and preventive health services.
• EMTALA: The Emergency Medical Treatment and Labor Act requires hospitals to stabilize patients in emergencies, regardless of ability to pay.
• Mifepristone: The first of two medications commonly used in medication abortion; approved by the FDA in 2000.
• USAID: This year, the Trump administration destroyed nearly $10 million worth of taxpayer-funded contraceptives, budgeted by the US Agency for International Development (USAID), and intended for low-income countries. 

Mifepristone: The first of two medications commonly used in medication abortion; approved by the FDA in 2000.

• EMTALA: The Emergency Medical Treatment and Labor Act requires hospitals to stabilize patients in emergencies, regardless of ability to pay.

Resources

Cal Matters - California files suit to restore Planned Parenthood funding
Bloomberg Law - HHS Silence on Medicaid Cuts Leaves Planned Parenthood in Limbo
Susan B Anthony Pro-Life America - Defunding Victories: The Full List of 2025 Planned Parenthood Closures
Abortion Everyday - The Catholic Hospital System Killing Women
AAMC - CMS Rescinds EMTALA Guidance on Hospital Obligation to Provide Emergency Abortions
LA Times - Emergency abortion denials by Catholic hospitals put woman in danger, lawsuit claims
Guttmacher Institute - Three Years Post-Roe: The Escalating Campaign to Make Abortion Inaccessible Nationwide (opinion)
PBS News - Rise of crisis pregnancy centers highlights shift in anti-abortion movement